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Cataract surgery rationing in an age of austerity – Is a UK district general hospital compliant with regional cataract booking guidelines?
Author(s) -
HO J,
MOORE S,
PAUL B,
ISLAM N
Publication year - 2012
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.s122.x
Subject(s) - medicine , cataract surgery , audit , optometry , diabetic retinopathy , visual acuity , ophthalmology , glaucoma , diabetes mellitus , management , economics , endocrinology
Purpose The rate of cataract surgery in Outer North East London (ONEL) is significantly higher than the standardised admission rate (SAR) for England. Financial pressures have forced cost savings by restricting cataract operations, aiming for 22% reduction through new clinical acceptance criteria for the region since April 2011. This involves: 1. Best corrected distance visual acuity 6/10 or worse in the better eye AND Impaired lifestyle due to cataract: OR 2. Severe glare, diplopia or anisometropia >/= 1.5 D Exceptions include: • Significant posterior subcapsular lens opacity despite good vision • If surgery is needed to help co‐manage conditions such as glaucoma or for the view of the retina in patients with diabetic retinopathy Methods Retrospective audit of cataract surgery from Aug 2010 ‐ Dec 2011. Medisoft electronic database query identified patients with VA > 6/9 for case‐note review to ascertain reasons for (non/)compliance with cataract booking criteria. Results 1084 cataract operations were performed. Median age was 73.5 years. n=34 eyes with pre‐op VA 6/9 or better; pre‐April 2011 (9 cases) vs post‐April 2011 (25 cases). Case‐note review revealed: • Glare (8) / Anisometropia (3): 11 • Posterior Subcapsular cataract: 4 • Co‐management of other pathology: 23 Glaucoma (15), Diabetic Retinopathy (7), ARMD (1) • Not valid: 2 Conclusion Rationing must be balanced with individual clinical needs. 99.8% of cataract operations met the new restricted criteria. This sample is an underestimate as not all cataract operations are registered on the Medisoft database. A re‐audit in 6‐8 months would establish compliance and feasibility as policies are tightened.